Project Summary/Abstract Project Background/Rationale Musculoskeletal spine pain, including neck (NP) and low back pain (LBP), result in significant disability and health care utilization and is among the top ten most prevalent conditions affecting veterans. Pilot work for this proposal identified more than 500,000 individuals treated for low back pain in 2005 and more than 282,000 individuals who were treated for neck pain in 2007. Estimated costs in 2005 exceeded $282,000,000. However, little VA research exists and none of the nine Quality Enhancement Research Initiatives focus on spine pain, in part, because considerably more formative research is needed. Project Objectives This is a retrospective observational study to describe the burden and natural history of neck and low back pain in VA and assess the influence of the VHA/DOD Clinical Practice Guideline for the Management of LBP in Primary Care on outcomes defined as index episode duration. The specific aims of the project are to: 1. Describe the characteristics of veterans who seek care for NP and LBP, including socio- demographic and clinical characteristics 2. Describe the treatment provided to veterans with NP or LBP and the cost of that treatment 3. Describe the outcomes of care for veterans who seek treatment for NP and LBP, where outcomes are defined as index episode duration and probability of first recurrence 4. Assess episode duration for veterans with LBP who receive VHA/DOD guideline concordant care to those who do not Methods We will create a person-level utilization dataset for all veterans who received health care services for low back or neck pain between 2000 and 2007, by linking inpatient (Patient Treatment File) and outpatient (National Patient Care Database), Fee Basis, DSS pharmacy and VA Medicare datasets. We will differentiate between acute and subacute or chronic episodes, and complete the descriptions in the specific aims. Selecting only those cases with low back pain alone, we will compare current VA practice to the VHA/DOD Clinical Practice Guideline for the Management of LBP in Primary Care, and assess the influence of the guideline on episode duration for veterans with LBP.